ABSTRACT

A 33 year-old Caucasian male with underlying type one diabetes mellitus, dyslipidemia, hypothyroidism, and nephrotic syndrome secondary to membranous glomerulonephropathy (GN), presented with new onset tonic-clonic seizures (lasting one minute) after an episode of binge drinking in which there was a considerable period of immobilization. The patient was taking 80 mg of atorvastatin daily at the time of presentation. The patient was intubated and ventilated and initial laboratory investigations confirmed a creatine kinase (CK) of 12,000 U/L (normal 20-220 U/L) and creatinine of 3.1 mg/dL (normal 0.7-1.3 mg/dL), and associated symptomatic hyperkalemia of 5.6-5.9 mmol/L (normal 2.5-5.0 mmol/L). The patient developed acute kidney injury (AKI) presumed secondary to rhabdomyolysis, and required renal replacement therapy. His CK eventually peaked at 153,741 U/L on the seventh day of admission. The patient regained consciousness and improved clinically over the following weeks. A muscle biopsy performed on the 29th day of admission showed changes consistent with polymyositis. On follow-up testing, the patient’s TSH was noted to be 101.99 mIU/L (normal 0.5-5.0 mIU/L) with a T4 of 5.5 pmol/L (normal 8.5-15.2 pmol/L) indicating uncontrolled hypothyroidism. This case highlights multiple potential etiologies causing rhabdomyolysis that may occur concurrently in a patient and contribute to AKI.